Overview

• Atopic Eczema ⇒
  • Sx → itchy, erythematous rash. In infants, the face and trunk are often affected. In younger children, often affects the extensor surfaces. In older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck.
  • Mx → avoid irritants, simple emollients, topical steroids (once or twice daily for up to 14 days - LIBERAL USE), wet wrapping.
    • Mild (areas of dry skin, infrequent itching) → emollients + mild topical corticosteroids (hydrocortisone 1%).
    • Moderate (frequent itching) → above + moderate topical corticosteroids (betamethasone 0.025% or clobetasone 0.05%) + topical calcineurin inhibitors (tacrolimus) + bandages.
    • Severe (incessant itching) → above + potent topical corticosteroids (betamethasone 0.1%) + wet wrapping + phototherapy + systemic therapy.
    • Infected (Staph.Aureus Infection - oozing from swollen, sore skin with yellow crust) → oral flucloxacillin.
      • Ix → skin swab and culture.
    • Eczema Herpecticum (HSV Infection - fever, widespread blisters, punched-out lesions, typically around face) → admit + oral aciclovir.
      • May look similar to impetigo.
      • Differentiate from secondary bacterial infection → rapid onset and quick spread, typically around face, high fever and systemic symptoms.
    • Indications for Referral
• Hand, Foot and Mouth Disease ⇒
  • Most commonly caused by coxsackie virus.
  • Sx → mild systemic upset (sore throat and fever), oral ulcers, vesicles on palms and soles of feet. May also be found around the groin or buttocks.
  • Mx → symptomatic/supportive treatment, don’t need school exclusion.
• Roseola Infantum ⇒

  • Caused by human herpes virus 6. Typically affects young children, 6-24 months old.

  • Sx → febrile phase. As fever subsides, a blanching rose-pink macular rash appears predominantly on trunk but may also spread to face and limbs.

    <aside> 💡 Several days of high temperatures followed by a widespread rash that starts on the torso/neck.

    </aside>

  • Mx → fever control with antipyretics (supportive). Monitor for complications such as febrile convulsions. No school exclusion required.

• Scarlet Fever ⇒
  • Caused by Group A haemolytic streptococci (usually Streptococcus pyogenes). Primary affects children around 4 years old.
  • Sx → fever, sore throat, ‘strawberry tongue’, ‘sandpaper rash’.
  • Mx → oral penicillin for 10 days (azithromycin if penicillin-allergic).
    • School exclusion for 24 hours after starting antibiotics. Notifiable disease (inform HPU).
  • Complications → otitis media (most common), rheumatic fever (20 days after infection), acute glomerulonephritis (20 days after infection).
• Impetigo ⇒
  • Highly infectious superficial bacterial skin infection caused by staphylcoccus aureus. May be complication of existing eczema, scabies or insect bites.
  • Sx → golden, crusted skin lesions around the mouth. Very contagious.
  • Mx → 1st Line: hydrogen peroxide 1% cream (localised non-bullous + systemically okay) and 2nd Line: topical antibiotic cream (topical fusidic acid - widespread non-bullous + systemically okay).
    • Widespread / Bullous / Systemically Unwell → oral flucloxacillin.
      • Bullous Impetigo → in children <2yo, large fluid-filled blisters, but no redness surrounding.
    • Children should be excluded from school until the lesions are crusted + healed OR 48 hrs after starting antibiotics.
• Seborrhoeic Dermatitis ⇒
  • Common in newborns (presents in first 6 weeks). Typically presents as greasy, yellow scales on the scalp (’cradle cap’) but can also affect the face, ears and neck.
    • Associated with Malassezia yeasts.
  • Mx → 1st line (scalp affected): regular washing with baby shampoo, soaking crusts with white petroleum gelly, emulsifying ointment. 2nd line (scalp affected): topical imidazole cream. 3rd line (if severe): mild topical steroids (1% hydrocortisone).
  • Tends to resolve spontaneously within 8 months.
• Nappy Rash ⇒
  • Form of contact dermatitis, babies 3-15 months of age.
  • Sx → irritant: well-demarcated variety of erythema, oedema, dryness or scaling that spares skin folds (just skin in contact with nappy is erythematous). Candida Albicans: satellite lesions (small red spots away from the main area of redness) or superficial pustules, involves the flexures.
  • Mx → high-absorbency nappies, leave nappy off as much as possible, change every 3-4 hours/immediately after soiling.
    • Mild Erythema and Asymptomatic Child → barrier preparation (zinc barrier cream).
    • Moderate Erythema and Discomfort → hydrocortisone 1% cream (max 7 days).
    • Candidal Infection → advice against use of barrier protection, topical imidazole cream.
    • Bacterial Infection → oral flucloxacillin for 7 days.
• Milia ⇒
  • White pimples on nose and cheeks, from retention of keratin and sebaceous material of the pilosebaceous follicle.
  • Sx → affects up to 50% of newborns.
  • Mx → self-limiting.
• Tinea (Ringworm) ⇒
  • Fungal infection → dermatophyte fungi invade dead keratinous structures.
    • Scabies → mx: permethrin.
  • Sx → ringed appearance + kerion (severe inflamed ringworm patch).
  • Mx:
    • Tinea Faciei/Corporis/Cruris/Pedis → mild: topical antifungals (terbinafine cream, clotrimazole), moderate: hydrocortisone 1% cream, severe: oral antifungals (1st: oral terbinafine, 2nd: oral itraconazole).
    • Tinea Capitis → oral antifungal (terbinafine).
• Haemangioma ⇒
  • Infantile Haemangioma →
  • Congenital Haemangioma →
• Neck Lumps ⇒
  • Most commonly lymphadenitis (background of an inflammatory/infective process).
  • Red-Flags → sepsis, poor feeding, rapid progression, stridor, change in voice.
  • Thyroglossal Cyst → midline congenital mass. Moves with swallowing.
  • Branchial Cleft Abnormality → lateral congential mass.
  • Lymphadenitis → most common neck lump in children. Transiently enlarged, tender lymph nodes. May often be multiple small tender bumps.

Making Diagnosis

Clinical Features

Investigations

Management Plan